Clear Blue Pools and Spa LLC - 888-630-POOL

Employment Application

Programs, services and employment are available equally to everyone. Please, inform Human Resources Department if you require reasonable accommodation to the application or interview.

APPLICATION DATA

Date Position applied for
How were you referred to us? Social security #
Full Name (Last, First, Middle)
Present address City State Zip
Permanent address City State Zip
Phone Other Phone Email
Date available to start
Last day available to work Salary requirement
If you are under 18 and we require a work permit, can you furnish one? Yes No
If no, please explain
Have you ever applied for this company? Yes No If yes, when?
Have you ever worked with this company? Yes No If yes, when?
If yes, what was the reason for leaving?
Are you a citizen of the United States? Yes No If no, do you have work permit? Yes No
Type of employment desired Full-time Part Time Temporary Seasonal
Have you ever pled "guilty" or "no contest" to or been convicted of a crime or felony? Yes No
If yes, give dates and details
Answering yes to these questions does not constitute an automatic rejection to employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be consideration.
Driver's license number, if applicable to position State

EDUCATION

High School Address
# of Years Completed Did you graduate? Yes No Degree
Major GPA Class Rank
College/University Address
# of Years Completed Did you graduate? Yes No Degree
Major GPA Class Rank
Other Address
# of Years Completed Did you graduate? Yes No Degree
Major GPA Class Rank

REFERENCES

Please furnish the names, addresses and telephone numbers of two people to whom you are not related
1. Name Phone
Address City State Zip
2. Name Phone
Address City State Zip

SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS

EXPERIENCE/PREVIOUS EMPLOYMENT (begin with most recent job)

- Dates of employment
- Company, address, phone
- Position(s) held
- Supervisor / Manager
- Salary/ Title
- Responsi bilities
- Reason for leaving
- From / To /
- Name Address Phone
- Name Title Name Title
- Start Salary Title End Salary Title
May we contact this employer for reference? Yes No If no, please explain
- From / To /
- Name Address Phone
- Name Title Name Title
- Start Salary Title End Salary Title
May we contact this employer for reference? Yes No If no, please explain
- From / To /
- Name Address Phone
- Name Title Name Title
- Start Salary Title End Salary Title
May we contact this employer for reference? Yes No If no, please explain

MEDICAL

Do you have any medical conditions?

Final

I certify, that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application. In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.
Signature of Applicant Date